Hand Pain

Your hand probably has more structures in it than you realize. There are 27 bones, about 30 joints, and a complicated array of nerves, muscles and ligaments involved with movement.

For those people having hand pain, I’d like to share some of the more common reasons your hand might be hurting.

Carpal Tunnel Syndrome

This is a nerve entrapment syndrome that occurs at the wrist. The bones of the wrist make a C-shape like an arch that allows tendons, nerves and vessels to pass from the forearm to the hand. This is the carpal tunnel. If the shape of this tunnel changes or collapses, well then you can imagine that the things that pass through the tunnel can become compressed. This leads to a particular pattern of pain and numbness in the palm, thumb, index, middle, and half of the ring finger. Fixing this problem usually involves repositioning the bones with manipulation to form the arch again, then doing stretches and exercises to train the wrist to keep the correct shape of the arch.

Ulnar Tunnel Syndrome

This is another nerve entrapment syndrome, though less common than carpal tunnel syndrome, the idea is the same. There is a tunnel on the side of the hand called the “tunnel of Guyon” and the ulnar nerve passes through it. If the shape of the hand changes, or if there is trauma or inflammation, then this can affect this space and compress the nerve. Ulnar Tunnel Syndrome causes pain and numbness in the pinky and ring finger. We fix this the same way… we reposition the bones with manipulation and retrain the muscles in the hand to hold the position.

De Quervain’s Tenosynovitis

This is a mouthful to say, but it’s simple really. There is a set of tendons that cross the wrist in order to move the thumb around. These tendons are covered by a sheath that helps them move smoothly. The tendons and the sheath can become inflamed and irritated. This can lead to scar tissue formation which can cause problems with the tendon sliding inside of this sheath. Pt’s usually experience pain on the side of the wrist at the base of the thumb and across the wrist sometimes into part of the forearm. My treatment for this usually involves ultrasound, soft tissue techniques, manipulation, exercise, and home instructions for icing and splinting.

Ganglion Cysts

These are also known as bible bumps. They are soft, non-cancerous, but sometimes painful bumps that occur in the hand and wrist as a result of inflammation of the joint or tendon. This inflammation stimulates the over-production of fluid. This can lead to little out-pouchings that stick up underneath the skin. Treating the underlying cause of the inflammation is important. This means assessing the hand and improving the mechanics to diminish the cause of the inflammation. Sometimes these go away on their own. Sometimes the go away and come back. Some people have them surgically removed only for them to grow again. So even if you have had surgery or plan on getting surgery, the mechanical dysfunction can persist creating another cyst. Therefore, you should address the underlying dysfunction to truly correct the problem.

Sprains and Strains

Sprains are ligament damage while strains are muscle damage. This is common in falls or sports injuries. A fairly common injury is the classic “stubbed finger”. This typically results in damage to the capsules in the finger joints. Depending on how old the damage is, the treatment varies. The acronym PRICE is great for remembering Protection, Rest, Ice, Compression, and Elevation for acute injuries (recent). But, It is often not enough just to let the damage heal on its own. I can’t tell you how many conditions I end up treating that are old injuries left untreated that turn into osteoarthritis after several years. If the joints are not aligned and a proper recovery is not made, those joints end up having dysfunction that cause excess wear and tear over the years. Just like a misaligned tire, the damage is worse the more you use it. Get these taken care of sooner rather than later.

Arthritis

Often the result of an old injury, as mentioned above, or a repetitive-type microtrauma, osteoarthritis is the leading kind of arthritis we find affecting the joints of the hand. The base of the thumbs is usually the most commonly affected area followed by the wrist joints. The second most common type of arthritis is rheumatoid arthritis. This typically affects both hands and affects the smaller joints of the fingers first. Other types of arthritis like gout affect the hands to differing degrees. Treatment for these different arthritides (plural for arthritis) varies depending on the type, degree, and how long it’s been around. If you would like to know more about arthritis, please visit our arthritis page.

Trigger Finger

This is named for the locked position of the finger mimicking the action of pulling a trigger. The lock happens because scar tissue creates a ball that becomes entrapped when the finger is flexed. Imagine a break cable on a bicycle. It is a wire that goes through a rubber or plastic casing. Now imagine that there is a knot in the metal cable and a kink in the casing. The knot gets stuck in the kink and cannot slide through the casing. This is exactly what happens in trigger finger. The cable is the finger tendon, the casing is the sheath of the tendon, and the knot is the scar tissue. The scar tissue causes the tendon to get stuck and not be able to slide through the sheath. This is quite similar to De Quervain’s above. This scar tissue needs to be broken down again for the tendon to be able to slide through and do its job.

If you are having hand pain, we would be happy to see you. We will determine the cause and the appropriate treatment for your condition. Most of these problems get worse with time and become more difficult to treat. So please don’t wait, especially if there has been an injury. Make an appointment today or call for a free consultation 918-600-2969.

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